Hematology reference intervals for transgender adults on stable hormone therapy

Dina N Greene; Gabrielle Winston McPherson; Jessica Rongitsch; Katherine L Imborek; Robert L Schmidt; Robert M Humble; Nicole Nisly; Nancy J Dole; Susan K Dane; Janice Frerichs; Matthew D Krasowski

doi:10.1016/j.cca.2019.02.011

Hematology reference intervals for transgender adults on stable hormone therapy

Clin Chim Acta. 2019 May:492:84-90. doi: 10.1016/j.cca.2019.02.011. Epub 2019 Feb 13.

Authors

Affiliations

¹ Department of Laboratory Medicine, University of Washington, Seattle, WA, United States. Electronic address: dina.n.greene@kp.org.
² Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.
³ Capitol Hill Medical, Seattle, WA, United States.
⁴ Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
⁵ Department of Pathology, University of Utah, Salt Lake City, UT, United States.
⁶ Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.
⁷ Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States.
⁸ Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.

PMID: 30771301
DOI: 10.1016/j.cca.2019.02.011

Abstract

Background: The complete blood count (CBC) is a cornerstone of patient care. Several of the normal values for the components of the CBC differ by sex and, therefore, male-specific and female-specific reference intervals are required to interpret these laboratory results. Transgender individuals are often prescribed hormone therapy to affirm their gender, with resulting serum hormone concentrations similar to those of cisgender individuals. Gender-specific reference intervals for transgender men and women have not been established for any laboratory measurements, including hematology. We established clinically relevant hematological reference intervals for transgender individuals receiving stable hormone therapy.

Methods: Healthy transgender individuals prescribed testosterone (n = 79) or estrogen (n = 93) for ≥12 months were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Concentrations for hemoglobin, hematocrit, MCV, MCHC, and RDWCV, as well as counts for red cells, white cells, and platelets, were evaluated. Results were interpreted in reference to the overall distribution of values and relative to serum estradiol and total testosterone concentrations. Calculated reference intervals were compared to established cisgender reference intervals.

Results: Regardless of serum hormone concentration, individuals prescribed testosterone or estrogen had hematology parameters that were not clinically different from cisgender males and females, respectively.

Conclusion: The hematology parameters for transgender men and women receiving stable hormone therapy should be evaluated against the cisgender male and cisgender female reference ranges, respectively and does not require concurrent sex hormone analysis. Care providers can utilize this observation to aid in interpretation of hematology laboratory values for transgender people.

Keywords: CBC; Hematocrit; Hematology; Hemoglobin; Hormone therapy; Laboratory; Non-binary; Normal range; Reference interval; Transgender.

MeSH terms

Adult
Estrogens / blood
Female
Gonadal Steroid Hormones / blood
Hematology / standards*
Hemoglobins / metabolism
Hormones / therapeutic use*
Humans
Male
Middle Aged
Reference Values
Surveys and Questionnaires
Transgender Persons*
Young Adult

Substances

Estrogens
Gonadal Steroid Hormones
Hemoglobins
Hormones